The Changing Face of Hepatocellular Carcinoma: Forecasting Prevalence of Nonalcoholic Steatohepatitis and Hepatitis C Cirrhosis

Ahmed, Osmanuddin; Liu, Lisa; Gayed, Antony; Baadh, Amanjit S.; Patel, Mikin V.; Tasse, J.; Turba, Ulku C.; Arslan, Bülent

doi:10.1016/j.jceh.2018.02.006

Cited by 25 publications

(14 citation statements)

References 20 publications

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“…With the advent of effective cures, the US national predictions project a decline in the contribution of HCV to the cirrhosis and HCC burdens and liver transplant utilisation coinciding with a rise in NAFLD impact on these burdens and resources . Thus, in this context, the observed significant rise in cirrhotic NAFLD HCC in this study is an important finding that confirms current AASLD guideline recommendations of surveillance for HCC in patients with NAFLD cirrhosis .…”

Section: Discussionsupporting

confidence: 83%

Characteristics, aetiologies and trends of hepatocellular carcinoma in patients without cirrhosis: a United States multicentre study

Gawrieh

Dakhoul

Miller

et al. 2019

Aliment Pharmacol Ther

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Summary Background Limited data exist on the burden and features of non‐cirrhotic hepatocellular carcinoma (HCC) in the United States. Aim To evaluate characteristics, aetiologies, trends and outcomes of non‐cirrhotic HCC from 2000 to 2014 at five large US centres Methods Patient, tumour and liver disease aetiology data were collected. The presence of underlying cirrhosis was assessed based on published criteria. Results Of 5144 eligible patients with HCC, 11.7% had no underlying cirrhosis. Non‐cirrhotic patients were older (64.1 vs 61.2 years), more frequently females (33.9% vs 20.8%) and less frequently black (8.3% vs 12.4%) (P < .001 for all). Among non‐cirrhotic patients, non‐alcoholic fatty liver disease (NAFLD) was the most common liver disease (26.3%), followed by hepatitis C virus (HCV) (12.1%) and hepatitis B virus (HBV) (10%) infections. As of 2014, there was increased percentage of cirrhotic HCC and a decline in non‐cirrhotic HCC mainly due to significant annual increases in cirrhotic HCC due to HCV (0.96% [P < .0001]) and NAFLD (0.66% [P = .003]). Patients with non‐cirrhotic HCC had larger tumours (8.9 vs 5.3 cm), were less frequently within Milan criteria (15% vs 39%), more frequently underwent resection (43.6% vs 8%) (P < .001 for all) and had better overall survival than cirrhotic HCC patients (median 1.8 vs 1.3 years, P = .004). Conclusions Nearly 12% of HCCs occurred in patients without underlying cirrhosis. NAFLD was the most common liver disease in these patients. During the study, the frequency of non‐cirrhotic HCC decreased, whereas that of cirrhotic HCC increased. Although non‐cirrhotic patients presented with more advanced HCC, their survival was better.

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Section: Discussionsupporting

confidence: 83%

Characteristics, aetiologies and trends of hepatocellular carcinoma in patients without cirrhosis: a United States multicentre study

Gawrieh

Dakhoul

Miller

et al. 2019

Aliment Pharmacol Ther

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“…Ahmed's model suggests that NASH prevalence exceeded HCV prevalence in 2006, and NASH's contribution to HCC overtook HCV-related HCC in 2015 at an approximately 25 million persons. 86 In 2025, the number of HCV-infected people is predicted to reach 1 million, whereas the number with NASH will reach 17-42 million, according to the model used. Between 45 000 and 106 000 cases of CHC-NASH are expected to occur in 2025, compared with 18 000 HCV-related HCC cases.…”

Section: Future Trends In Hcc Incidencementioning

confidence: 99%

“…In the USA, although the prevalence of alcoholic cirrhosis remained stable between 1995 and 2013, the incidence of HCV cirrhosis saw an increase between 1999 and 2012. Ahmed's model suggests that NASH prevalence exceeded HCV prevalence in 2006, and NASH's contribution to HCC overtook HCV‐related HCC in 2015 at an approximately 25 million persons 86 . In 2025, the number of HCV‐infected people is predicted to reach 1 million, whereas the number with NASH will reach 17‐42 million, according to the model used.…”

Section: Future Situationmentioning

confidence: 99%

Epidemiological projections of viral‐induced hepatocellular carcinoma in the perspective of WHO global hepatitis elimination

Quang

Shimakawa

Nahon

2021

Liver International

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Hepatitis B is an eminent risk factor for hepatocellular carcinoma (HCC) in Southeast Asia and sub-Saharan Africa, whereas hepatitis C is a key risk factor for HCC in Western Europe and North America. Increased awareness of the global burden of viral hepatitis resulted, in May 2016, in the adoption of the first global health sector strategy on viral hepatitis by the World Health Assembly, which calls for the elimination of viral hepatitis as a public health threat by 2030. Although the incidence of liver cancer resulting from viral infections has increased since the 1990s, the implementation of public health interventions, such as hepatitis B vaccination and antiviral therapies might have reduced the global burdens of HCC. Hepatitis B immunization in infancy has been associated with a reduction in the risk of infant fulminant hepatitis, chronic liver disease, and HCC in Taiwan. Achieving viral hepatitis elimination by 2030 can be accelerated by improving the access to HCC screening programs. HCC surveillance programs in developed countries must be refined to increase an access to personalized surveillance program, whereas the limited access to surveillance and treatment of HCC in developing countries remains a significant public health issue.

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“…NASH is one of the leading etiologies of HCC, with projection models showing the NASH contribution to HCC overtaking chronic hepatitis C by 2025. ( 39 ) In general, the 5‐year survival rate for HCC from all etiologies is low (approximately 15%) due to diagnosis at a late stage. ( 40 ) Patients with cirrhosis should be screened every 6 months with liver imaging so that they can be diagnosed early at a curable stage.…”

Section: Clinical Disease Progression and Liver‐related Complicationsmentioning

confidence: 99%

Nonalcoholic Fatty Liver Disease Screening in Type 2 Diabetes Mellitus Patients in the Primary Care Setting

Barbosa

Lai

2020

Hepatol Commun

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Nonalcoholic fatty liver disease (NAFLD) is a major public health problem worldwide and the most common chronic liver disease. NAFLD currently affects approximately one in every four people in the United States, and its global burden is expected to rise in the next decades. Despite being a prevalent disease in the general population, only a minority of patients with NAFLD will develop nonalcoholic steatohepatitis (NASH) with advanced liver fibrosis (stage 3‐4 fibrosis) and liver‐related complications. Certain populations, such as patients with type 2 diabetes mellitus (T2DM), are recognized to be at the highest risk for developing NASH and advanced fibrosis. Both the American Diabetes Association and the European Association for the Study of Diabetes recommend screening of all T2DM for NAFLD. Incorporating a simple noninvasive algorithm into the existing diabetic care checklists in the primary care practice or diabetologist’s office would efficiently identify patients at high risk who should be referred to specialists. The proposed algorithm involves a first‐step annual fibrosis‐4 score (FIB‐4) followed by vibration‐controlled transient elastography (VCTE) for those with indeterminate or high‐risk score (FIB‐4 ≥1.3). Patients at low‐risk (FIB‐4 <1.3 or VCTE <8 kPa) can be followed up by primary care providers for lifestyle changes and yearly calculation of FIB‐4, while patients at high risk (FIB‐4 ≥1.3 and VCTE ≥8 kPa) should be referred to a liver‐specialized center. Conclusion: Patients with T2DM or prediabetes should be screened for NASH and advanced fibrosis. The proposed simple algorithm can be easily incorporated into the existing workflow in the primary care or diabetology clinic to identify patients at high risk for NASH and advanced fibrosis who should be referred to liver specialists.

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The Changing Face of Hepatocellular Carcinoma: Forecasting Prevalence of Nonalcoholic Steatohepatitis and Hepatitis C Cirrhosis

Cited by 25 publications

References 20 publications

Characteristics, aetiologies and trends of hepatocellular carcinoma in patients without cirrhosis: a United States multicentre study

Characteristics, aetiologies and trends of hepatocellular carcinoma in patients without cirrhosis: a United States multicentre study

Epidemiological projections of viral‐induced hepatocellular carcinoma in the perspective of WHO global hepatitis elimination

Nonalcoholic Fatty Liver Disease Screening in Type 2 Diabetes Mellitus Patients in the Primary Care Setting

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